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Acute paraplegia due to schistosomiasis: an uncommon cause in developed countries

  • Anthony Chauvin
  • Aiham Ghazali
  • Claire Le Jeunne
  • Patrick Plaisance
  • Tali Anne Szwebel
  • Nathalie Costedoat-Chalumeau
  • Frederic Beubon
  • Peggy Reiner
  • André Paugam
  • Romain Paule
Case Report
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Abstract

We present a case of a young African migrant from Guinea-Conakry presented to a French emergency department with burning pain in both feet for 2 days. The symptoms progressed to limb paraparesis with sphincter disorders. A magnetic resonance imaging (MRI) scan showed a hyperintense spinal cord lesion without contrast enhancement extending from the T6 vertebrae to the conus medullaris. Cerebrospinal fluid exam (CFE) showed an isolated hyperproteinorachia (0.61 g/l). Schistosomiasiss serology was positive and a rectal biopsy showed a schistosoma egg surrounded by an inflammatory reaction with granulomatosis. After steroid and antihelminthic therapy, accompanied by intensive physical therapy, the patient had an improved neurological neurological outcome.

Keywords

Acute paraplegia Neuro-medullary schistosomiasis 

Notes

Authors contributions

- AC: managed the patient, wrote and designed the case report

- AG: made corrections, wrote and designed the case report

- CLJ: made corrections

- PP: made corrections

- TAS: made corrections and managed the patient

- NCC: made corrections and managed the patient

- FB and AP: performed microbiological investigations

- PR: managed the patient

- RP: managed the patient, wrote and designed the case report

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Consent to publish was obtained from the patient.

References

  1. Batson OV (1940) The function of the vertebral veins and their role in the spread of metastases. Ann Surg 112:138–149CrossRefGoogle Scholar
  2. Carod Artal FJ (2012) Cerebral and spinal schistosomiasis. Curr Neurol Neurosci Rep 12:666–674CrossRefGoogle Scholar
  3. Carod Artal FJ, Vargas AP, Horan TA, Marinho PB, Coelho Costa PH (2004) Schistosoma mansoni myelopathy: clinical and pathologic findings. Neurology 63:388–391CrossRefGoogle Scholar
  4. Carod-Artal FJ (2008) Neurological complications of Schistosoma infection. Trans R Soc Trop Med Hyg 102:107–116CrossRefGoogle Scholar
  5. Colley DG, Bustinduy AL, Secor WE, King CH (2014) Human schistosomiasis. Lancet 383:2253–2264CrossRefGoogle Scholar
  6. do Amaral LLF, Nunes RH, da Rocha AJ (2015) Parasitic and rare spinal infections. Neuroimaging Clin N Am 25:259–279CrossRefGoogle Scholar
  7. Ferrari TCA (2010) A laboratory test for the diagnosis of neuroschistosomiasis. Neurol Res 32:252–262CrossRefGoogle Scholar
  8. Ferrari TCA, Moreira PRR, Cunha AS (2004) Spinal cord schistosomiasis: a prospective study of 63 cases emphasizing clinical and therapeutic aspects. J Clin Neurosci 11:246–253CrossRefGoogle Scholar
  9. Ferrari TCA, Moreira PRR, Sampaio MJ, da Cunha AS, de Oliveira JT, Gazzinelli G, Correa-Oliveira R (2006) Intrathecal cytokines in spinal cord schistosomiasis. J Neuroimmunol 177:136–141CrossRefGoogle Scholar
  10. Ferrari TCA, Faria LC, Vilaça TS, Correa CR, Góes AM (2011) Identification and characterization of immune complexes in the cerebrospinal fluid of patients with spinal cord schistosomiasis. J Neuroimmunol 230:188–190CrossRefGoogle Scholar
  11. Fowler R, Lee C, Keystone JS (1999) The role of corticosteroids in the treatment of cerebral schistosomiasis caused by Schistosoma mansoni: case report and discussion. Am J Trop Med Hyg 61:47–50CrossRefGoogle Scholar
  12. Freitas ARR, Oliveira ACP, Silva LJ (2010) Schistosomal myeloradiculopathy in a low-prevalence area: 27 cases (14 autochthonous) in Campinas, São Paulo, Brazil. Mem Inst Oswaldo Cruz 105:398–408CrossRefGoogle Scholar
  13. Global Burden of Disease Study 2013 Collaborators (2015) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386:743–800CrossRefGoogle Scholar
  14. Gryseels B (2012) Schistosomiasis. Infect Dis Clin N Am 26:383–397CrossRefGoogle Scholar
  15. Hotez PJ, Kamath A (2009) Neglected tropical diseases in sub-saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis 3:e412CrossRefGoogle Scholar
  16. Jauréguiberry S, Paris L, Caumes E (2010) Acute schistosomiasis, a diagnostic and therapeutic challenge. Clin Microbiol Infect 16:225–231CrossRefGoogle Scholar
  17. Lai Y-S, Biedermann P, Ekpo UF, Garba A, Mathieu E, Midzi N, Mwinzi P, N’Goran EK, Raso G, Assaré RK, Sacko M, Schur N, Talla I, Tchuenté LAT, Touré S, Winkler MS, Utzinger J, Vounatsou P (2015) Spatial distribution of schistosomiasis and treatment needs in sub-Saharan Africa: a systematic review and geostatistical analysis. Lancet Infect Dis 15:927–940CrossRefGoogle Scholar
  18. Olson S, Rossato R, Guazzo E (2002) Spinal schistosomiasis. J Clin Neurosci 9:317–320CrossRefGoogle Scholar
  19. Ruberti RF, Saio M (1999) Epidural Bilharzioma mansoni compressing the spinal cord: case report. East Afr Med J 76:414–416PubMedGoogle Scholar
  20. Saconato H, Atallah A (2000) Interventions for treating schistosomiasis mansoni. Cochrane Database Syst Rev:CD000528Google Scholar
  21. Silva LC dos S, Maciel PE, Ribas JGR et al (2004) Schistosomal myeloradiculopathy. Rev Soc Bras Med Trop 37:261–272CrossRefGoogle Scholar
  22. Weerakoon KGAD, Gobert GN, Cai P, McManus DP (2015) Advances in the diagnosis of human schistosomiasis. Clin Microbiol Rev 28:939–967CrossRefGoogle Scholar
  23. Zhu H, Yu C, Xia X, Dong GY, Tang J, Fang L, du Y (2010) Assessing the diagnostic accuracy of immunodiagnostic techniques in the diagnosis of schistosomiasis japonica: a meta-analysis. Parasitol Res 107:1067–1073CrossRefGoogle Scholar

Copyright information

© Journal of NeuroVirology, Inc. 2019

Authors and Affiliations

  • Anthony Chauvin
    • 1
  • Aiham Ghazali
    • 2
  • Claire Le Jeunne
    • 3
  • Patrick Plaisance
    • 1
  • Tali Anne Szwebel
    • 3
  • Nathalie Costedoat-Chalumeau
    • 3
  • Frederic Beubon
    • 4
  • Peggy Reiner
    • 5
  • André Paugam
    • 6
  • Romain Paule
    • 3
  1. 1.Emergency Department, Hôpital Lariboisière, Assistance Publique - Hôpitaux de ParisUniversity DiderotParisFrance
  2. 2.Emergency Department, Hôpital Bichat, Assistance Publique - Hôpitaux de ParisUniversity DiderotParisFrance
  3. 3.Department of internal medicine, Hôpital Cochin, Assistance Publique - Hôpitaux de ParisUniversity Paris-DescartesParisFrance
  4. 4.Department of anatomopathology, Hôpital Cochin, Assistance Publique - Hôpitaux de ParisUniversity Paris-DescartesParisFrance
  5. 5.Department of Neurology, Hôpital Lariboisière, Assistance Publique - Hôpitaux de ParisUniversity DiderotParisFrance
  6. 6.Department of parasitology, Hôpital Cochin, Assistance Publique - Hôpitaux de ParisUniversity Paris-DescartesParisFrance

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